Risk factors for Toxoplasma gondii seropositivity in the Old Order Amish.

Toxoplasma gondii (T. gondii) is an important human disease-causing parasite. In the USA, T. gondii infects >10% of the population, accrues economic losses of US$3.6 billion/year, and ranks as the second leading culprit of foodborne illness-related fatalities. We assessed toxoplasmosis risk among the Old Order Amish, a mostly homogenous population with a high prevalence of T. gondii seropositivity, using a questionnaire focusing on food consumption/preparation behaviours and environmental risk factors. Analyses were conducted using multiple logistic regression. Consuming raw meat, rare meat, or unpasteurised cow or goat milk products was associated with increased odds of seropositivity (unadjusted Odds Ratios: 2.192, 1.613, and 1.718 , respectively). In separate models by sex, consuming raw meat, or consuming unpasteurised cow or goat milk products, was associated with increased odds of seropositivity among women; washing hands after touching meat with decreased odds of seropositivity among women (adjusted OR (AOR): 0.462); and cleaning cat litterbox with increased odds of seropositivity among men (AOR: 5.241). This is the first study to assess associations between behavioural and environmental risk factors and T. gondii seropositivity in a US population with high seroprevalence for T. gondii. Our study emphasises the importance of proper food safety behaviours to avoid the risk of infection.

Red blood cell transfusions increase fecal calprotectin levels in premature infants.

OBJECTIVE: We hypothesized that red blood cell (RBC) transfusions influence intestinal inflammation in very low birth weight (VLBW) infants. We also suspected that hematocrit (Hct) at transfusions and RBC storage time correlate with intestinal inflammation. STUDY DESIGN: VLBW infants, without major congenital defects, intestinal perforation or necrotizing enterocolitis, were enrolled prospectively. Fecal calprotectin (FC) levels were measured from stool samples collected before and after RBC transfusions. Data on Hct and RBC storage time were collected. RESULT: Data from 42 RBC transfusions given to 26 infants revealed that FC levels increased faster than baseline after RBC transfusions (P=0.018) and were higher in multiple-transfused infants (0 to 48 and >48 h post transfusion, P=0.007 and P=0.005, respectively). Lower Hct and RBC storage >21 days correlated with higher FC levels (P=0.044 and P=0.013, respectively). CONCLUSION: RBC transfusions, anemia and prolonged RBC storage were associated with an increase in intestinal inflammation.

Integrated science modules: preparing non-nurse MSN students in the basic sciences.

Many nursing programs are developing masters degree tracks for non-nurses. The author discusses the use of integrated science modules as an independent, successful, and less traditional approach to these students learning needs.

Prevalence and predictors of adolescent dating violence.

This study of 561 rural North Carolina adolescents examined relationships among race, parental educational level, family structure, parental discipline, family violence exposure, and dating violence experiences. The sample was predominantly female (77%), with 40% black and 58% white. The subjects ranged in age from 15 to 20 years; 80% of the adolescents were 16-18. Dating violence experiences were assessed by a researcher-constructed instrument measuring warning signs of potential violence and actual violent experiences. The results suggested that recognition of abusive relationships is difficult, with many adolescents denying such a relationship but actually reporting numerous abusive events. Sixty percent had experienced violent acts during dating relationships; 24% reported extreme violence (episodes of rape, use of weapons). More than 20% of the adolescents reported family violence and 2.2% reported family sexual abuse. The study suggests new avenues for research in adolescent date violence, and for interventions with high risk groups.

Adolescent stress factors: implications for the nurse practitioner.

This article present results of a descriptive study designed to assess gender differences in stress factors of adolescents attending rural, urban and suburban public schools. The Roy Adaptation Model of Nursing was selected as the theoretical framework for the study. Subjects were 323 freshmen in high schools in eastern Tennessee; mean age was 15.5 years. Most frequently reported stressors were hassling with parents, hassling with siblings, and making new friends. There was little difference between boys and girls in prevalence of these stress factors. However, gender differences in amount and types of other stressors were identified. Regardless of geographic location, mean stress scores of females were higher; urban females reported the highest stress levels. Females were more concerned with self-concept issues and interdependence issues, whereas males were more concerned with role function issues. Nurse practitioners and school nurses have unique opportunities to promote improved adaptation in adolescents experiencing stress. Intervention strategies are proposed for each of the four adaptation modes delineated by Roy.

Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives.

Studies in adults have shown that the oropharyngeal route can be used to effectively and safely administer interferon-alpha, an immune cell-derived cytokine, to patients who are unable to tolerate its parenteral administration. The mechanism for this appears to be the stimulatory effects of the cytokine, on the oropharyngeal-associated lymphoid tissue system. Own mother's colostrum (OMC) is rich in cytokines and other immune agents that provide bacteriostatic, bacteriocidal, antiviral, anti-inflammatory and immunomodulatory protection against infection. OMC may be especially protective for the extremely low birth weight (ELBW) infant in the first days of life; however clinical instability typically precludes enteral feedings during this period. Oropharyngeal administration is a potential alternative method of providing OMC. Oropharyngeal administration of OMC may have immunomodulatory effects on the recipient infant, and would be especially beneficial to the ELBW infant who would otherwise remain nil per os during the first days of life.

Relationship of breastfeeding and formula-feeding practices with infant health outcomes in an urban poor population.

The article reports a study examining symptoms of infection and use of medications and the health care system by breastfeeding or formula-feeding urban poor mothers. A prospective, self-report design was used. Mothers completed a demographic and anthropometric questionnaire, an infection checklist, and a medication and health care system survey. Results showed that more of the breastfeeders were white, older, and economically better off than formula feeders. Scores on the infection checklist were higher for those feeding their infants by bottle. Colds, rashes, episodes of vomiting, ear infections, colic, and health care utilization were less frequent for breastfed infants. This small study suggests that there is a protective effect of breastfeeding in this population and provides a basis for larger epidemiologic and cross-sectional studies.

Relationship of demographic, life-style, and stress variables to blood pressure in adolescents.

The relationship of selected predictor variables to blood pressures of freshman students (N = 323) attending rural, urban, and suburban high schools was examined. Independent variables included 7 anthropometric and demographic factors, 10 life-style factors, and 38 stress factors. Significant predictors of higher systolic pressure in the regression analysis were age, gender, body mass index, and urban residence. Urban subjects also had poorer health habits. Significant predictors of diastolic pressure were body mass index, smoking, and lack of regular exercise. Gender differences in amount and types of stressors were independent of geographic location. Males and females exhibited different dietary and exercise patterns; males exercised more, but had less healthy eating habits.

Adolescent stress and coping: a longitudinal study.

The purpose of this longitudinal panel study was to investigate developmental and gender influences on stress and coping in adolescents attending a suburban high school in Tennessee. Data were collected from the same 167 subjects during the freshman year and again during the senior year. Life events stress was measured through the Adolescent Life Change Event Scale (ALCES) and ways of coping were categorized from data gathered from an open-ended questionnaire. Girls reported more life events stress at both testings than boys. Life events stress was greater at senior testing for both girls and boys, but girls' scores increased more. The "gender intensification" phenomenon may account for the greater disparity in types of stress reported by boys and girls as seniors. Girls generally reported more life events associated with interpersonal and family relationships. Both girls and boys reported coping with stress mostly through active distraction techniques such as exercise. However, girls' use of active distraction decreased over time, while passive distraction increased. Self-destructive and aggressive coping behaviors increased for boys. There were no relationships between amounts or types of life events stress and ways of coping for subjects at either time.

Characterizations and psychoneuroimmunologic implications of secretory immunoglobulin A and cortisol in preterm and term breast milk.

This article combines data from two separate investigations. One study examined relationships between psychosocial factors and preterm milk immune variables. The other examined relationships between psychosocial and breastfeeding satisfaction factors and perceived milk sufficiency in term mothers. Milk samples were collected on the fifth postpartum day and frozen. Both studies collected data on anxiety, but other psychosocial variables differed. Mood states and social support were studied in preterm mothers, while breastfeeding satisfaction, milk maturation, and infant suckling characteristics were studied in term mothers. Milk samples were assayed for secretory immunoglobulin A (sIgA) and cortisol. sIgA and cortisol levels were higher in the milk from preterm mothers and were inversely related to each other in both preterm and term milk. In preterm mothers, anger and vigor were positively correlated with higher milk sIgA. The findings suggest that cortisol is present in milk and may potentially influence the secretion of milk sIgA. The relationships that were found when comparing psychosocial, dyadic, and stress factors with milk sIgA and cortisol are provocative and suggest new paradigms for studying lactation.